Thyroid Panel Results

jdthoosier · Jul 2, 2018

Thoughts? I'll be 60 in a month. My TSH has steadily increased over the 4 years on TRT, from
below 1.00 to the current value. I'm not sure if this could be a function of the treatment, or the changes in my diet over this time; or other factors. This is the first panel I've done, albeit long overdue.

[TABLE="class: grid, width: 500"]
[TR]
[TD]Test[/TD]
[TD]Results[/TD]
[TD]Range[/TD]
[/TR]
[TR]
[TD]TSH[/TD]
[TD]3.34[/TD]
[TD]0.450-4.500[/TD]
[/TR]
[TR]
[TD]Reverse T3[/TD]
[TD]22.0[/TD]
[TD]9.2-24.1[/TD]
[/TR]
[TR]
[TD]Antistreptolysin O Ab[/TD]
[TD]23.9[/TD]
[TD]0.0-200.0[/TD]
[/TR]
[TR]
[TD]Thyroid Peroxidase (TPO) Ab[/TD]
[TD]14[/TD]
[TD]0-34[/TD]
[/TR]
[TR]
[TD]Triiodothyronine (T3), Free[/TD]
[TD]2.9[/TD]
[TD]2.0-4.4[/TD]
[/TR]
[TR]
[TD]T4, Free Direct[/TD]
[TD]1.32[/TD]
[TD]0.82-1.77[/TD]
[/TR]
[/TABLE]

Vettester Chris · Jul 2, 2018

jdthoosier said:
Thoughts? I'll be 60 in a month. My TSH has steadily increased over the 4 years on TRT, from
below 1.00 to the current value. I'm not sure if this could be a function of the treatment, or the changes in my diet over this time; or other factors. This is the first panel I've done, albeit long overdue.

[TABLE="class: grid, width: 500"]
[TR]
[TD]Test[/TD]
[TD]Results[/TD]
[TD]Range[/TD]
[/TR]
[TR]
[TD]TSH[/TD]
[TD]3.34[/TD]
[TD]0.450-4.500[/TD]
[/TR]
[TR]
[TD]Reverse T3[/TD]
[TD]22.0[/TD]
[TD]9.2-24.1[/TD]
[/TR]
[TR]
[TD]Antistreptolysin O Ab[/TD]
[TD]23.9[/TD]
[TD]0.0-200.0[/TD]
[/TR]
[TR]
[TD]Thyroid Peroxidase (TPO) Ab[/TD]
[TD]14[/TD]
[TD]0-34[/TD]
[/TR]
[TR]
[TD]Triiodothyronine (T3), Free[/TD]
[TD]2.9[/TD]
[TD]2.0-4.4[/TD]
[/TR]
[TR]
[TD]T4, Free Direct[/TD]
[TD]1.32[/TD]
[TD]0.82-1.77[/TD]
[/TR]
[/TABLE]

OK, good stuff on the thyroid, you got the correct labs, good job!

Your FT3 is at 37.5% of reference range
Your FT4 is at 52.6% of reference range

Ideally, it would be good to see both of these values between 50% and 80% of reference range, with TSH < 2.0. Your TPO Ab isn't over the top, but there is some detection. Make sure you are adding selenium and iodine to your routine.

At a glance, a lot of physicians would probably get you going on a hypothyroidism treatment protocol. However, there's one variable that is key, and I suggest you explore it first ... Your Reverse T3 ... Although it's not over reference, I like to see where it sits in relation to Free T3 and the ratio thereof. Your FT3/RT3 ratio is at 13.18. Different communities have different opinions on this, but for me I'd like to see it > 20.

RT3 can elevate and have an imbalance with FT3 for simple things like having a cold or flu, mild injury, or/ and stress. Or it can be more complicated with a myriad of illnesses and/or infection, and more common it can be an imbalance in iron & ferritin, and also with cortisol (which obviously plays into stress and other factors). Even certain elctrolytes and D3 can play a role with all of it, but my first advise is to look at iron/ferritin and cortisol first. If iron/ferritin is low, FT3 "will not" adequately reach the cells. The body will then shift to a higher conversion of T4 - RT3 conversion. Same story with cortisol.

Again, great job on thyroid labs, BUT, needing iron, ferritin, TIBC, CBC's, comp metabolic panel, and a 4x saliva cortisol w/DHEA correlation analysis would be the icing on the cake. We need to see the circadian profile of your adrenals "if" you have it checked(?)

Let us know, and if any of these other labs are in your possession please post them up on this thread.

Thanks!!

jdthoosier · Jul 2, 2018

Thanks Chris!

I'm inclined to the iron/ferritin angle. My last ferritin test was back in 2016, and my result was 24, where
the reference range was 30-400 ng/mL. So I'll get more tests done.

Vettester Chris · Jul 2, 2018

jdthoosier said:
Thanks Chris!

I'm inclined to the iron/ferritin angle. My last ferritin test was back in 2016, and my result was 24, where
the reference range was 30-400 ng/mL. So I'll get more tests done.

Yeah, definitely if your ferritin is below 100 there's going to be a struggle getting T3 to the cells. Sometimes the problem is with donating too frequently. I know, it happened to me before. It would also be good to see iron serum in the 120 - 150 range. Your inclination is probably spot-on, check it out, let us know. Might need to look at some different elemental iron regiments, but let's see what your results are ...

jdthoosier · Jul 13, 2018

Thyroid Panel Results - with Iron

Here's the iron results. My ferritin is still very low, but that is the highest I've seen in a long time.
Not sure why it's so hard to raise it.

[TABLE="class: grid, width: 500, align: left"]
[TR]
[TD]Tests[/TD]
[TD]Result[/TD]
[TD]Units[/TD]
[TD]Reference[/TD]
[/TR]
[TR]
[TD]Iron Bind (TIBC)[/TD]
[TD]309[/TD]
[TD]ug/dL[/TD]
[TD]250-450[/TD]
[/TR]
[TR]
[TD]UIBC[/TD]
[TD]207[/TD]
[TD]ug/dL[/TD]
[TD]111-343[/TD]
[/TR]
[TR]
[TD]Iron[/TD]
[TD]102[/TD]
[TD]ug/dL[/TD]
[TD]38-169[/TD]
[/TR]
[TR]
[TD]Iron Saturation[/TD]
[TD]33[/TD]
[TD]%[/TD]
[TD]15-55[/TD]
[/TR]
[TR]
[TD]Ferritin, Serum[/TD]
[TD]30[/TD]
[TD]ng/mL[/TD]
[TD]30-400[/TD]
[/TR]
[/TABLE]

Vettester Chris · Jul 13, 2018

JD, thanks for posting ... As noted in prior comments, both iron & ferritin are crucial for T3 to reach the cells. If that doesn't happen then Pooling will be a problem, as well as an increased level of RT3.

Can you give us a summary on your diet and supplements? Have we covered and/or are you up to speed with elemental iron, Vitamin C, and dietary methods to improve this area?

Also, do you have a current CBC and metabolic panel? Are you donating blood, and if so how often?

ratbag · Jul 13, 2018

You have Hashimoto's disease as indicated by your TPO. It's an autoimmune issue where your own cells attack your thyroid. Your low ferritin explains your high RT3 so'll you'll need to supp some iron. And of course a TSH thats over 2 indicates there is a problem somewhere.

More info in this thread:
https://www.excelmale.com/forum/showthread.php?15467-TPO-Thyroglobulin-Antibody&p=114488#post114488

jdthoosier · Jul 14, 2018

1. I can almost map the TSH rising trend to just over 4 years ago when I both started TRT, and was placed on a gluten-free diet by my nutritionist. I eat a very clean whole foods balanced diet: lots of fruits/veggies/seeds/nuts/artisan gluten-free whole grains/greens/beans/fermented foods along with fish, sometimes eggs/chicken/bison. I suspect that changing over to a clean diet like this means not eating fortified products that have iron/etc added in; so maybe I am short on iron.

2. I'm not a big fan of supplements/vitamins per se, especially B vitamins, but I do citrulline, ubiniquol, Vitamin D3, low dose zinc/copper, and magnesium.

Attached are my CBC results from Feb/2018. The low platelets is a known issue that has been there for over at least 20 years - and I've seen a blood specialist, undergone additional testing, even a bone marrow biopsy, all negative. I was told that this was just "my normal". My WBC has pretty much been on the low end for a while also - and again testing indicated nothing awry. I don't get sick. Although I'm the oldest guy in my shop at work, I'm by far the healthiest. My PCP suspected maybe I just have lower levels of inflammation.

Vince · Jul 14, 2018

jdthoosier said:
1. I can almost map the TSH rising trend to just over 4 years ago when I both started TRT, and was placed on a gluten-free diet by my nutritionist. I eat a very clean whole foods balanced diet: lots of fruits/veggies/seeds/nuts/artisan gluten-free whole grains/greens/beans/fermented foods along with fish, sometimes eggs/chicken/bison. I suspect that changing over to a clean diet like this means not eating fortified products that have iron/etc added in; so maybe I am short on iron.

2. I'm not a big fan of supplements/vitamins per se, especially B vitamins, but I do citrulline, ubiniquol, Vitamin D3, low dose zinc/copper, and magnesium.

Attached are my CBC results from Feb/2018. The low platelets is a known issue that has been there for over at least 20 years - and I've seen a blood specialist, undergone additional testing, even a bone marrow biopsy, all negative. I was told that this was just "my normal". My WBC has pretty much been on the low end for a while also - and again testing indicated nothing awry. I don't get sick. Although I'm the oldest guy in my shop at work, I'm by far the healthiest. My PCP suspected maybe I just have lower levels of inflammation.

View attachment 5389

Any heart valve issues? I'm not saying that you have any heart issues. But when a heart valve is starting to fail the body can adjust by lowering it's platelets and adjusting for the bad valve. It doesn't happen in all cases but it does in some.

jdthoosier · Jul 14, 2018

Checking my blood tests - my ferritin was just 14, three years ago. It has slowly but surely risen from 14 to 20 to 24 to now 30.

No heart valve issues that I'm aware - nothing has ever shown up and I've actually have visited a cardiologist. Among other things 4 years ago, I lost 20+ pounds, and that caused my pulse to drop low. They did scans, found nothing. The only definite conditions found was low testosterone and that I have the primary celiac genetic marker.

MarkM · Jul 14, 2018

Good thing you having the ferritin moving upward but I'd say you still have a long way to go. Optimally you'd probably want it up around 130 to 150 but for the thyroid to function properly you probably need to get it to 100, 80 at a minimum.